Peer-reviewed article
Measuring routine childhood vaccination coverage in 204 countries and territories, 1980–2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1
Natalie C Galles, Patrick Y Liu, Rachel L Updike, Nancy Fullman, Jason Nguyen et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic analysis measured routine childhood vaccination coverage across 204 countries and territories from 1980 to 2019 using data from over 55,000 observations. Global coverage of key vaccines like DTP3 and measles more than doubled since 1980, and the number of children who never received any doses fell by 75%. However, progress stalled between 2010 and 2019, with 94 countries showing decreasing coverage and only 11 countries reaching the 90% coverage target by 2019.
Key points
- Global DTP3 coverage increased from 39.9% in 1980 to 81.6% in 2019
- Measles vaccine (MCV1) coverage rose from 38.5% in 1980 to 83.6% in 2019
- Zero-dose children (never vaccinated) decreased by nearly 75%, from 56.8 million to 14.5 million
- Vaccine coverage growth plateaued after 2010, with 94 countries recording decreasing DTP3 coverage since that year
- Only 11 of 204 countries reached the Global Vaccine Action Plan target of 90% coverage for all vaccines by 2019
Limitations
This is a descriptive epidemiological analysis measuring coverage trends rather than evaluating an intervention. It does not explain the causes of stalled progress or test solutions to improve vaccination rates.
Abstract
BACKGROUND: Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. METHODS: For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. FINDINGS: By 2019, global coverage of third-dose DTP (DTP3; 81·6% [95% uncertainty interval 80·4-82·7]) more than doubled from levels estimated in 1980 (39·9% [37·5-42·1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38·5% [35·4-41·3] in 1980 to 83·6% [82·3-84·8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42·6% (41·4-44·1) in 1980 to 79·8% (78·4-81·1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56·8 million (52·6-60·9) to 14·5 million (13·4-15·9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. INTERPRETATION: After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. FUNDING: Bill & Melinda Gates Foundation.